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Phantom urinary incontinence in children with bladder-bowel dysfunction
Angela M Arlen1, Liisa L Dewhurst1, Susan S Kirsch2
1Department of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA.
Insights
Phantom urinary incontinence (PUI) is a condition where children feel wet but are dry. Treatment involving bladder-bowel management effectively resolves PUI and associated symptoms in most cases.
Area of Science:
- Pediatric Urology
- Child Psychology
- Urodynamics
Background:
- A novel condition, phantom urinary incontinence (PUI), is characterized by the sensation of wetness in children who are actually dry.
- This entity presents a diagnostic challenge in pediatric urology.
Purpose of the Study:
- To describe the characteristics of phantom urinary incontinence (PUI).
- To evaluate the management and outcomes of children diagnosed with PUI.
Main Methods:
- A retrospective review of 20 children diagnosed with PUI between 2009 and 2013.
- Data collected included demographics, bladder/bowel symptoms, diagnoses, and treatment outcomes.
Main Results:
- The study included 20 children (18 females, 2 males) with a mean age of 6.9 years.
- Ninety-five percent had lower urinary tract symptoms, and all had constipation.
- Obsessive-compulsive traits were reported in 70% of patients; 72% of girls had vaginitis.
Conclusions:
- Children with PUI frequently exhibit obsessive-compulsive traits.
- A comprehensive bladder-bowel regimen led to resolution of PUI and associated symptoms in 90% of cases.
Objective:
To report a previously undescribed condition in which children present with the sensation of wetness because of presumed urinary incontinence when they are actually completely dry. We have termed this entity "phantom" urinary incontinence (PUI).
Materials And Methods:
Twenty children referred to our pediatric urology clinic were diagnosed with PUI between 2009 and 2013. Patient demographics, associated bladder and bowel symptoms, concomitant diagnoses, imaging, management, and treatment outcomes were evaluated.
Results:
Twenty children (18 females and 2 males) were diagnosed with PUI over a 5-year interval. Mean age at diagnosis was 6.9 ± 2.5 years (range, 4-12 years). Nineteen patients (95%) had concomitant lower urinary tract symptoms, and all were also diagnosed with constipation. Urgency (75%) and frequency (50%) were the most common associated bladder symptoms. Of the 18 girls, 13 (72%) had associated vaginitis. Fourteen children (70%) carried a parent-reported diagnosis of obsessive-compulsive disorder or obsessive-compulsive disorder personality traits. Patients were managed with timed voiding, dietary modifications, and a bowel regimen. Ninety percent children experienced improvement of bladder-bowel dysfunction and resolution of PUI at a mean follow-up of 14.4 months.
Conclusion:
Children with PUI have a high incidence of obsessive-compulsive traits. Phantom incontinence as well as associated lower urinary tract symptoms resolve with adherence to a strict bladder-bowel regimen.
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